title: [Radical prostatectomy for high-risk prostate cancer].
abstract: Treatment for high-risk prostate cancer(PCa)(cT3 PCa, Gleason score 8-10 or PSA>20 ng/mL)remains controversial. Radiotherapy with androgen deprivation therapy(ADT)is widely used for high-risk prostate cancer. However, there is a considerable overlap of outcomes among risk groups, suggesting that the so-called high-risk prostate cancer group consists of a heterogeneous population in terms of tumor biology. Actually, the over-staging of cT3a PCa is relatively frequent and occurs in 13-27%of cases. Thus, radical prostatectomy(RP)alone is a reasonable treatment option for selected patients with high-risk prostate cancer. RP can provide an excellent biochemical and clinical progression-free survival for these patients if they have a pathologically organ-confined disease, or their tumors are extirpated completely with a negative surgical margin. A thorough preoperative evaluation, including imaging study and the use of a nomogram, is mandatory for selecting candidates appropriate for RP. Our recent study indicates that a positive biopsy core percentage is a strong independent predictor of organ-confined disease in these high-risk patients. In cases of adverse tumor characteristics, such as positive surgical margin, extraprostatic extension and seminal vesicle invasion, the patient must be informed of the likelihood of a multimodal approach. The use of adjuvant radiotherapy may be reasonable after recuperation from surgery. Immediate ADT may be indicated for those with positive pelvic lymph node.
authors.affiliation: Dept. of Urology, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Arai
authors.forename: Naoki
authors.initials: N
authors.lastname: Kawamorita
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kaiho
authors.forename: Shigeto
authors.initials: S
authors.lastname: Ishidoya
mesh_terms: D001706:Biopsy; D017024:Chemotherapy, Adjuvant; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D012307:Risk Factors